Provider Demographics
NPI:1457471252
Name:DYER, CAROLYN A (LADC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:A
Last Name:DYER
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 SHIRLEY RD
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-1622
Mailing Address - Country:US
Mailing Address - Phone:978-687-6300
Mailing Address - Fax:
Practice Address - Street 1:599 CANAL ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1244
Practice Address - Country:US
Practice Address - Phone:978-687-6300
Practice Address - Fax:978-682-4843
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1053101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)